卵巢肿瘤超声造影与微血管密度的相关性研究

Correlation between contrast transvaginal sonography and angiogenesis in ovarian mass

目的探讨卵巢良恶性肿物超声造影特征及其与微血管密度(MVD)的相关性。方法对41例常规超声发现卵巢肿瘤但良恶性鉴别诊断困难的患者行经阴道超声造影检查,其中29例(良性组14例,恶性组15例)行时间-强度曲线(TIC)分析。41例卵巢肿物组织均行病理免疫组化CD34染色,MVD计数测定微血管密度;对两组卵巢肿物超声造影PI、AUC与MVD计数值行相关性分析。结果 41例卵巢肿物经妇科手术、腹腔镜或超声引导活检、病理及免疫组化染色诊断良性20例(浆液性乳头状囊腺瘤5例,浆液性乳头状腺纤维瘤2例,子宫内膜异位囊肿3例,囊性成熟性畸胎瘤2例,卵泡膜细胞瘤及纤维瘤7例,卵巢脓肿1例),病灶最大径1.5～6.8cm,平均(4.0±2.3)cm;恶性21例(26个肿瘤,浆液性乳头状腺癌11例,子宫内膜样腺癌2例,透明细胞癌2例,纤维肉瘤1例,转移癌5例),肿物最大径1.7～9.3cm,平均(4.6±1.8)cm。超声造影显示:(1)良性与恶性组肿物超声造影PI值分别为(13.5±8.3)及(20.3±5.2)dB;AUC分别为(8.2±5.9)及(17.5±5.0);恶性组肿物PI及AUC超声造影测值均高于良性组,差异有统计学意义(P<0.05)。(2)恶性组MVD计数值(65.3±22.3)高于良性组(43.1±20.4),两组肿物MVD计数值比较差异有统计学意义(P<0.01)。(3)良性组与恶性组肿物PI、AUC测值与MVD计数值间有显著相关性(r=0.595,r=0.533,P=0.002)。结论卵巢良性与恶性肿物超声造影PI、AUC与其微血管密度检测结果有显著相关性,超声造影及病理免疫组化微血管密度测值分析有助于术前对卵巢肿物良恶性作出诊断性提示。

Objective To assess the correlation between the parameters of peak intensity （PI） and area under curve （AUC） and angiogenesis in ovarian mass by contrast-enhanced transvaginal ultrasound. Methods Forty-one patients with ovarian masses were enrolled in this study. Each patient took contast-en- hanced transvaginal examination. A total of 29 cases including 14 benign and 15 malignant masses were ana- lyzed by time-intensity curve （TIC）. The parameters of PI and AUC were obtained by ACQ software （ Axi- usTM auto tracking contrast quantification）. The patients were divided into benign and malignant groups ac- cording to the pathological findings. Immunohistochemistry was performed to evaluate the level of microvessel density （MVD） in ovarian masses. Then the relationship between PI, AUC and the level of MVD was statis- tically analyzed between the two groups. Results （ 1 ） The values of PI in benign and malignant were 13.5 ± 8.3 and 20.3 ±5.2 dB, respectively. （2） The values of AUC in benign and malignant were 8.2 ± 5.9 and 17.5 ± 5.0, respectively. （ 3 ） The MVD values in ovarian benign and malignant groups were 43.1 ± 20.4 and 65.3± 22.3, respectively. The value of PI, AUC and MVD in malignant group were signif- icantly higher than those of benign ones. The values of PI and AUC were significantly correlated with the level of MVD in ovarian masses （r = O. 595 and = 0.533,P = 0.002）. Conclusions The PI and AUC of ovarian masses in contrast transvaginal sonography had significant relationship with angiogenesis, which could be helpful for assessment of tumor vascular distribution in ovarian masses.